Bravo to bioethicist Lori Andrews who discussed the ethical problems of turning healthy short children into patients in need of a medical treatment. I agree with her belief that self-esteem doesn't come from buying inches. I understand, though, why parents would want to do what they can to help their short children grow taller. The fact that heightism is rampant in our culture influences many people to use growth hormone in an attempt to deal with the prejudice against short people. But in my opinion, the way to deal with heightism is to educate those who discriminate against short people, rather than trying to physically alter the victims of that prejudice.

Moreover, what the CNN story fails to mention, was that studies have shown that treatment with human growth hormone does not always translate into increased inches for the person undergoing the treatment, and that it looks like many recipients of growth hormone reach their adult height faster (so the rate of their growth is increased) but not taller. The young boy in the story who has gained 3 extra inches so far in treatment will not necessarily become 3 inches taller than his predicted adult height (and predicted height has a plus or minus 3 inch range). Also, the story reports that an extra inch costs about $50,000, which is true, and that if you want 4 extra inches, it will cost you $200,000. But studies show that for those children who do grow taller from the treatments, they add an average of one to one and a half extra inches...more money for treatment years does not translate into more inches. You can't just place an order for a particular height.

In addition, they CNN noted some potential side effects such as headaches and scoliosis but failed to mention the may potential adverse consequences of growth hormone therapy including: impaired glucose tolereance, diabetes, pseudotumor cerebri (a condition of the brain simulating the presence of an intracranial tumor), severe kidney damage, hypertension, and spontaneuos bone fractures. A small percentage of patients can be expected to form antibodies against growth hormone that can interfere with growth. Short-term acceleration of growth from human growth hormone therapy may hasten puberty and bone aging so that final adult height may actually be less than what it would have been without intervention. Similarly, stopping treatment before adult height is reached may render the child shorter than he/she would have been without treatment. Finally, growth hormone causes the liver to manafacture chemicals that have effects on various parts of the body. One of the chemicals, insulin-like growth factor (IGF-1) is thought to play a role in breast cell growth and many doctors are concerned about a possible connection with the development of breast cancer. Human growth hormone (the synthetic version) has only been in use since 1985, and many children receiving this treatment do so for an average of 5-10 years. There has been insufficient time to determine potential long term consequences. Remember, the child is being subjected to these potentially serious effects when there is nothing physically wrong with him/her. They are healthy short children who live in a culture who is biased against short people.

Another point I want to make, is that the child they featured who had a predicted adult height of 5 feet 5 inches tall, and has grown 3 inches since he's been using human growth hormone. In 2003, the FDA approved the use of human growth hormone in healthy short children who had a predicted adult height of less that 5 feet 3 inches tall for men and 4 feet 11 inches for women. Therefore, the child did not meet the criteria set by the FDA, (a concern because more and more short people are being considered in need of treatment) and his treatment is even being covered by his insurance! (What about all the uninsured children in the U.S. who have no health care?)

CNN did a good job of showing some of the ehtical debate of using growth hormone with healthy short children, but with the above mentioned concerns about what they didn't highlight, I think people will come away with the idea that human growth hormone treatment is a safe and effective way of increasing height.

For me there is only one solution. We must confront heightism as a social issue, and not medicalize the victims of height prejudice.

New study claims taller people are smarter

Well folks, heightism is unfortunately alive and well. A new study by Princeton economists claim that taller people are smarter than shorter people and that the findings justify higher pay for more height. Here is an MSNBC article about the study and its findings:

NEW YORK - While researchers have long shown that tall people earn more than their shorter counterparts, it’s not only social discrimination that accounts for this inequality — tall people are just smarter than their height-challenged peers, a new study finds.“As early as age 3 — before schooling has had a chance to play a role —and throughout childhood, taller children perform significantly better on cognitive tests,” wrote Anne Case and Christina Paxson of Princeton University in a paper published by the National Bureau of Economic Research.The findings were based primarily on two British studies that followed children born in 1958 and 1970, respectively, through adulthood and a U.S. study on height and occupational choice.Other studies have pointed to low self-esteem, better health that accompanies greater height, and social discrimination as culprits for lower pay for shorter people.But researchers Case and Paxson believe the height advantage in the job world is more than just a question of image.“As adults, taller individuals are more likely to select into higher paying occupations that require more advanced verbal and numerical skills and greater intelligence, for which they earn handsome returns,” they wrote.For both men and women in the United States and the United Kingdom, a height advantage of four inches equated with a 10 percent increase in wages on average.But the researchers said the differences in performance crop up long before the tall people enter the job force. Prenatal care and the time between birth and age 3 are critical periods for determining future cognitive ability and height.“The speed of growth is more rapid during this period than at any other during the life course, and nutritional needs are greatest at this point,” the researchers wrote.The research confirms previous studies that show that early nutrition is an important predictor of intelligence and height.“Prenatal care and prenatal nutrition are just incredibly important, even more so than we already knew,” Case said in an interview.Since the study’s data only included populations in the United Kingdom and the United States, the findings could not be applied to other regions, Case said.And how tall are the researchers?They are both about 5 feet 8 inches tall, well above the average height of 5 feet 4 inches for American women.A copy of the paper can be found by clicking here.Copyright 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content isURL: http://www.msnbc.msn.com/id/14517687/

Okay, let's get this straight. The researchers explain that early nutrition is an important predictor of both intelligence and height. That makes sense, but then the problem to address would be adequate nutrition as it affects both intelligence and height, not the spurious conclusion that taller people are smarter. Moreover, children who have access to adequate nutrition will still be different heights as a result of genetic make-up. The bell-shaped curve for height attests to the fact that while children may grow at the same speed, they grow at different percentiles. To conclude that the child growing an average of 2 inches per year at the 75% is better off than the child growing an average of 2 inches per year at the 5% is based on heightist notions. The deeply ingrained heightism so pervasive in our culture and in the work force makes it easy for people to make assumptions that short people are inherently inferior rather than looking at the societal forces that lead to such discrimination. There was a study by David Kurtz, an Eastern Michigan University marketing professor. He asked 140 recruits to make a hypothetical hiring choice between two equally qualified applicants, one 6 feet 1 inch tall, and the other 5 feet 5 inches tall, for a sales job. Seventy-two percent "hired" the tall one, twenty-seven percent expressed no preference, and one percent chose the short one. This has nothing to do with actual intelligence and everything to do with heightism. This study by the Princeton economists is reminiscent of Arthur Jenson’s conclusions back in 1969 when he published an article in the Harvard Educational Review maintaining the whites are genetically superior in intelligence to blacks. We understand racism. It’s time we take a serious look at heightism.

Sunday, July 30, 2006

Hi out there!

I am finally entering the world of blogging! I wanted my first post to be about my opposition to using human growth hormone with healthy short children. This is an issue I feel strongly about, and that contributed to my desire to write Beyond Measure: A Memoir About Short Stature and Inner Growth.

Stop Trying to Make Healthy Short Kids Taller

Many short children are perfectly healthy. Their height is a matter of genetic make-up rather than any medical problem resulting in short stature. Despite this, many parents are turning to human growth hormone injections in an attempt to add inches to their short child’s height. It’s understandable that parents worry about their children’s short stature because we live in a culture that favors certain body types above others. Heightism – the cultural bias favoring the tall over the short – is pervasive in our society, so parents often reason that trying to add inches will benefit their child. But beware: using human growth hormone treatment for healthy short children is potentially harmful on many levels.

People naturally come in different shapes and sizes: If you think of a bell-shaped curve to plot children’s height, you’ll find that most people fall in the middle (average height), fewer fall into the left or right of that middle (the shorter than average and the taller than average), and still fewer fall into the tail ends of the growth chart (the very short and the very tall). Targeting healthy children who fall into the shortest percentiles of a normal distribution for medical treatment is dangerous. It takes a social prejudice against short people, and treats the victims of that prejudice as patients in need of treatment. What we need instead is to educate those who discriminate against short people, not than the genetic engineering of its victims.Safety and efficacy of human growth hormone treatment: In 2003, the Federal Drug Administration approved the use of human growth hormone therapy for very short, healthy children, yet the safety and efficacy of this practice raises many red flags. Human growth hormone treatment involves subjecting the child to daily injections over an average of 5 years at cost of $20,000 per year. Research has revealed that on average, a child may add 1 to 1 ½ inches to final adult height, if any added inches occur at all. It appears that while some children may grow faster as a result of treatment, they don’t necessarily grow taller. In other words, they simply reach their adult height faster. Moreover, there are potentially serious side effects that include: a possible association with certain cancers, hypertension, spontaneous bone fractures, headaches, fevers, stomach problems, vomiting, impaired glucose tolerance, kidney damage, and a worsening of scoliosis. The synthetic version of human growth hormone has only been available since 1985, so the possible long-term adverse affects are unknown at this time.Height and self-esteem: Many doctors and parents believe that adding inches to a short child’s height will increase self-esteem. However, the treatment itself may potentially decrease self-esteem. What is the child to think about his or her own height if doctors and parents are prescribing human growth hormone treatment; that being short is unacceptable and therefore that they are unacceptable? Children often have the fantasy that growth hormone treatment will actually make them tall, when at most, it can offer an inch or two. What is the child to think after years of treatment and the bursting of the fantasy that the shots will make him/her tall? That he/she is forever unacceptable and doesn’t “measure-up?’ And if the child does gain an extra inch, he/she will still be short, but now the child has the added burden of years of treatment that is costly physically, emotionally and financially.Paying the price: Treatment is expensive, costing an average of $100,000 over five years. Who will have access to this costly treatment? Do we, as a society, want our limited health care dollars to go towards this type of intervention? If insurance doesn’t pay, only the wealthy will be able to afford treatment, making this into a class issue as well as size discrimination issue. How much greater will the prejudice against short people become if parents are now expected to “grow” their short children?Profiting from prejudice: By targeting the shortest height percentiles of a population, the pharmaceutical companies producing human growth hormone have insured that they have a built in population to treat that will boost profits significantly. Even if children were taller, on average, there will always be those who fall into the lowest tail ends of a bell shaped curve, providing endless potential recipients for treatment. This targeting of children supports and reinforces a social bias against short people, while business profits from that prejudice.

Being short can be a stressor in the lives of both short children and adults, from school playgrounds to corporate boardrooms. However, the great majority of problems that arise stem from the social prejudice directed against short people rather than any inherent problem in being short itself. The answer to this social issue must be in the form of combating the cultural bias against short people, not in trying to make the victims of that prejudice taller.